Provider Demographics
NPI:1700209681
Name:SMITH, JACLYN W (MA LPC-S)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA LPC-S
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:M
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4725 LAKE COVE WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:210-771-3034
Mailing Address - Fax:
Practice Address - Street 1:5351 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6720
Practice Address - Country:US
Practice Address - Phone:214-818-2600
Practice Address - Fax:214-818-2645
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional